RT Journal Article
SR Electronic
T1 Vertebral fracture and bone mineral density in women receiving high dose glucocorticoids for treatment of autoimmune diseases.
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 863
OP 869
VO 32
IS 5
A1 Shunichi Kumagai
A1 Seiji Kawano
A1 Tatsuya Atsumi
A1 Shigeko Inokuma
A1 Yosuke Okada
A1 Yoshinori Kanai
A1 Yoshiki Kanai
A1 Junichi Kaburaki
A1 Hideto Kameda
A1 Akira Suwa
A1 Hiroyuki Hagiyama
A1 Shunsei Hirohata
A1 Hirofumi Makino
A1 Hiroshi Hashimoto
YR 2005
UL http://www.jrheum.org/content/32/5/863.abstract
AB OBJECTIVE: To evaluate the factors influencing the occurrence of vertebral fracture in patients receiving high dose glucocorticoids (GC). METHODS: A cross-sectional study was performed on women who had received at least 0.5 mg/kg of oral glucocorticoid for the treatment of autoimmune diseases for more than 1 month between 1998 and 2003. Logistic regression analysis and chi-square test were used to examine the effects of glucocorticoid dose and other factors on vertebral fractures. Receiver-operating characteristics curve (ROC) analysis was used to determine the bone mineral density (BMD) cutoff value for the risk of vertebral fracture. RESULTS: The study population comprised 160 women, including 35 with vertebral fractures. In ROC analysis, the BMD threshold of the risk of fracture for postmenopausal women (0.787 g/cm2 , T score -2.1) was lower than that for premenopausal women (0.843 g/cm2 , T score -1.7). Among patients with fractures, 7 of 16 premenopausal patients had normal BMD values (T score > -1), whereas only one of 19 postmenopausal patients showed a comparable level of BMD. Additionally, vertebral fracture was more frequent for patients with high total cholesterol values (> 280 mg/dl) than for those with normal total cholesterol values (< 220 mg/dl). Moreover, patients with high total cholesterol values had lower BMD values than those with normal total cholesterol values. CONCLUSION: The fact that vertebral fracture frequently occurred in premenopausal patients with normal BMD and evidence that hyperlipidemia correlated with fracture suggest the pathology of vertebral fracture secondary to high dose glucocorticoid therapy is multifactorial and possibly involves lipid metabolism.